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CNO was 'appalled' by Mid Staffs scandal

8 February, 2013 | By The Press Association

The country’s top nurse has said colleagues who fail to demonstrate “compassion and empathy” to patients have no place in the NHS, following a damning report into failings of care at Stafford Hospital.

Jane Cummings, chief nursing officer for England, said she was “shocked and appalled” at the behaviour of some members of her profession after the findings of a public inquiry into Mid Staffordshire Trust were published.

Robert Francis QC, who led the inquiry, uncovered a “disaster” in the standards of basic care and medical treatment for some of the most vulnerable and elderly patients.

Writing in the Daily Telegraph, Ms Cummings said: “As a nurse of 30 years, I was shocked and appalled that members of our profession let patients down in this way, and betrayed the trust that they and their families had put in nurses and care staff, when they most needed help.

“People in Stafford are rightly upset and angry, and the report sets out some examples that are very hard to read.

“I would never want a member of my family to suffer the indignity, pain and fear that some patients at Stafford endured.”

Ms Cummings said that while there were many “excellent and committed” nurses working in the NHS, the evidence from Stafford hospital was “damning”.

She continued: “The reality is that there are some nurses who do not have the capacity to be compassionate and truly care, despite training and support.

“They have no place in the NHS. We only want nurses who come to work to make a difference for their patients and are prepared to take personal responsibility for individuals in their care.

“There is no room in the nursing and midwifery professions for people who don’t have empathy with their patients.”

Ms Cummings said she would work with NHS medical director Professor Bruce Keogh as he investigates the trusts with mortality rates higher than average.

She added: “I want the profession to work together, with honesty and openness, to rebuild the trust in our profession and make a positive difference to those we care for.”

In his inquiry into the trust, Mr Francis uncovered failings at every level of the NHS and said the culture among healthcare staff must change.

He said: “What we need to avoid is yet another wholesale reorganisation of abolishing organisations and creating new ones.

“This is about how people behave when they go to work and their ability to raise concerns and be honest about what’s going on in their hospitals.”

He said none of the 290 recommendations covered in his report “have been made lightly” and hoped all would be adopted in full.

The change would only happen when NHS managers, clinicians and staff started to address the failings “rather than waiting to be told what to do from Whitehall, or by the top of the NHS,” he added.

His comments came after it emerged there were 3,000 more deaths than expected at another five NHS trusts between 2010 and last year.

Professor Keogh has now launched a review into Blackpool Teaching Hospitals Trust, East Lancashire Hospitals Trust, Colchester Hospital University Trust, Basildon and Thurrock University Hospitals Trust and Tameside Hospital Trust.

Patients’ campaigner Julie Bailey, whose elderly mother Bella died at Stafford hospital, called for individuals in the NHS to be held accountable for the failings in care.

She said: “This is an opportunity to put down the gauntlet and say enough is enough.

“From today you will be held accountable for your actions - it’s no good saying in the future you will be held accountable.

“We want accountability for the hundreds of deaths and the suffering our loved ones had to put up with.”

Readers' comments
(48)

Anonymous | 8-Feb-2013 1:25 pm

This will be a new era for the nhs, its such a relief that things are being acknowledged. . . But extremely heartbreaking that it had come to this in order for those changes to be made and recognised by agencies and government. The culture of nursing today is not what it was 13 years ago when I commenced my nurse training. Year by year over the last 10 years the profession has been demoralised, I say this based on my my personal views and experiences. Compassion is the backbone to patient care. The financial climate has had a huge effect upon staffing levels, resources, funding for care packages/24 hr nursing care. The nurse to patient ratios have been unsafe over the last 10 years. The duration of shifts has increased along with this comes burnout. Ward managers are not supportive, in my experience, and do not know sometimes everything that is happening. If a nurse asks a collegue for help you get a sigh or the look of "do I have to? I was just thinking about my choice of sandwich from the canteen." Or you are placed upon capability because you are deemed as not being at the level expected with your experience. I have been told to my face that I am too nice. The regulators are unaware of this culture which is nurse eat nurse, staff are chosen by managers to speak to them. The audits, targets are not truthful. Mansgers also disclose to the rcn and regulators what they wsnt them to know. There is no transparency as the risk register and rcas, board meetings and department meetings are not available for the public to read. I know of a number of incidents on the risk register in my locality and the incidents involve the same nurse. Heparin sliding scale was afministeted at the wrong rate, human albumin solution 4% administered longer than prescribed and not checked with a pharmacist before administration which resulted in the overloading of a renal patient. Some nurses who I've worked with have a somewhat aggressive personality who lack insight into a patients needs holistically and the needs of relatives and carers. There is alot that needs to chsnge I could go on all day. . . One thing I have to say before I go is this report of mid staffs is just the tip of the iceberg. This could be any trust in the uk. Its the reality.

If inspections are carried out unannounced and with notice, it might give a more accurate snapshot of what is happening and without people making the odd special effort like when they get notified. This also happens when politicians and other celebrities visit hospitals, with their entourage and media in tow. Other than the incident of a consultant getting irate at the media for not following the bear below the elbows policy, who were following Cameron on his travels, I cannot recalling seeing in the news nurses, doctors + other staff being snowed under in a typical ward environment, where everything is going full tilt. On those 'ward / intentional' rounds by a (senior?) nurse on the News, there's not an empty biscuit wrapper or sandwich packet out of place, no half drunk tea cup and definitely no loose bits of tissues, that people love to hide/tuck around themselves or the bedside. Not good for the camera shots. Just a completely calm, clear, clean+tidy and with happy staff + patients, artificially set up scenario for a tv news crew. Where's the trying to cope + reassure a severely confused patient, where's the politicians helping with feeding at meal times or even talking with patients properly (probably face too many awkward questions), and hard to show under-staffed wards on the news.

Philip Collins, in today’s Times, below – he got the point, that the NHS has got to start listening to patient/relative feedback, and stop allowing clinicians and managers ‘to mark themselves’:

For the most shocking revelation of the Francis report is in the written and oral evidence from patients and relatives.For years they had been telling the hospital that it was a disgrace. But the hospital management didn't count personal stories as real knowledge. They were treated with arrogance and disdain. Instead, managers preferredthe carefully collected benchmarks and star ratings that came with the imprimatur of the Healthcare Commission. The hospital's chief executive dismissed its high level of mortality as a coding error.

In a system that is currently run by the staff for the staff, the NHS needs to let the public in.

Sounds to me like Jane Cummings is 'nurse bashing'. If managers don't know what is happening on the 'shop floor', then they are not doing their job. Blame for Mid Staffs should go all the way from the bottom to the top, local to national, and NHS staff to government (all of them). Everyone is accountable, and I hope they see what damage has been done to the NHS and the public.

is it right that the director of nursing got off scott free?, wasn't it her responsibility to ensure nurses were doing their job properly, that there were enough of them and that the ones who raised concerns were taken seriously.

none of us are perfect and we can only do one thing at a time safely (has anyone read that ridiculous headline stating that if a nurse can't do two things at once they are not a good nurse) but how can a patient not be offered a wash for a month?

Does anyone know what the staffing levels and skill mix was on the wards at Mid Staffs, were all the wards bad?

anon 1.45 - where do you work where the pharmacist checks IV albumin with the nursing staff? you blame one nurse for administering heparin incorrectly, is that a single nurse procedure where you work?

why wasn't she out there using her powers to do something about it instead of sitting in her office labouring over the 'Six Cs'. Nursing is a practical hands on front line job and that is where all of the damage was and possibly continues to be done.

One of the things that will presumably happen next - although to their credit Jane and the NMC seem to be not doing this - was pointed out on the King's Fund 'site by one Jim Edwards:

'Every organisation seems to be reacting to this report by agreeing how terrible the situation at Stafford was and agreeing with all the recommendations except the ones which directly threaten their own organizations.'

It is invariably easier for individuals, and individual professions, to discern the mistakes others are making, than to clearly see their own mistakes: this 'marking our own behaviour' is partly why such incoherent behaviour across a system, can occur in the first place.

And 'tick-box' behaviour, doesn't help either: as Mike Nicholls wrote in the same KF discussion:

‘I was a county councilor for 20 years and for much of that time I was responsible- for social care and health matters …….. One area that it is right to question is the modern trend for box ticking. One sometimes feels that there are people, who on being shown a new hospital wing will not believe in its existence, until they have seen the tick in the box’.'

It isn't enough to tell nurses that they must display 'compassion and empathy' - the rest of the system, must allow nurses to do that. You need 'systemic coherence' instead of the fragmentation that results, from 'everyone just doing my particular bit, in a blinkered manner'.

Its predictable that Jane Cummings would condemn nurses with uttering a word about the underlying reasons, such as chronic staff shortages which have been been reported time and again and which she steadfastly refuses to acknowledge. What about David Nicholson, head of the HNH who appointed a manager of the Trust who had no managerial experience. Mr Nicholson was himself was also the Regional Manager for the area at the time of the tragedy. He was promoted for his incompetence. It is much easier to blame nurses when things go wrong, managers will never accept responsibility.Ms Cummings should keep her mouth shut if she cannot offer something useful. But then she is a government poodle and her loyalty is to the government and not to nurses. Expect more such drivel as her 6 C's. The best thing we can do is to ignore this poodle and and tell her where to go.

You would hope it would be, it blatantly highlighted the systemic failures from top to bottom due to the market,target driven culture taking precedent over the actual patient experience. Unfortunately the people tasked with using this information are the same people who implemented and promoted this target driven culture in the first place.What they should take from this is poor staffing, poor management and lack of resources leades to bad care.What they will take from this is trying to develop some form of tick box exercise to try and measure 'good care' and performance related pay for nurses based on a hospitals results as a means to reduce nurses rising through their increments. Eithout actually providing the nurses with the staff or resources to do so.

I wonder how Jane Cummings CNO can retain the title of "Nurse" when she is employed as a civil servant and has not obviously worked as a practitioner for years. Are there different rules for the elite than for the ordinary nurse?

Yes, David Cameron has already announced that Nurses pay and increments should be linked to their caring ability. So he would seem to be singling out nurses for blame. No word of managers and doctors having to undergo this test. No doubt be is being advised in this by Jane Cummings. The Lord spare us from that woman!.

Within hours of the report’s publication, Sir David Nicholson, the chief executive of the NHS, appeared on the BBC. Sir David was head of the West Midlands Strategic Health Authority between 2005 and 2006, and was therefore the senior leader responsible for Stafford Hospital. He sounded quite chirpy. He pointed out – in case we might have doubted it – that he was “a human being”. In that capacity, he said he was “shocked” by what had happened at Stafford Hospital, and “sorry” too. But he fastened quickly on Mr Francis’s comforting words that the problem was the “culture” rather than any specific bad leadership. Sir David felt “pretty sure that I know broadly what we need to do”: he was staying.

In retaining his power, Sir David, who is a former member of the Communist Party of Great Britain, had already been endorsed by our political leaders. Jeremy Hunt, the Health Secretary, publicly backed him. David Cameron, in the House of Commons, expressed every confidence in the great man. The political calculation, reinforced by the close relationship between Sir David and the omnipresent Cabinet Secretary, Sir Jeremy Heywood, is that only Sir David can exercise the financial control and manipulation of waiting times required to prevent the NHS exploding politically at the next election. Much easier to pin the blame on nurses!

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